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The Omega-3 Pill That Worked (And Made Millions)

Corrections: An earlier version of this article stated that Amarin had
developed an Omega-3 supplement; rather, theirs, Vascepa, is
a highly-purified, FDA-approved Omega-3 medication.

Dietary supplements get a bad rap, and with good reason: they are not
clinically proven, they are not FDA approved and they seldom work.
omega-3 is one of the many such pills that Americans have taken for
decades without supporting evidence– which is why physicians were
dumbfounded when an omega-3 drug was found to significantly reduce the risk
of heart attack.

In fact, the manufacturer of the omega-3 pill tested, Amarin, saw its
stock soar over 500% following the announcement. Its market cap rose from
less than one billion to over five in mere days. Even prior to the
study, in 2017, the omega-3 drug had a product revenue of $180 million.

The drug, Vascepa, differs from most omega-3 dietary supplements in that its
key component, EPA, is in a highly purified state, while supplements usually
contain a mixture of EPA, DHA and other components. Vascepa is different
enough from existing omega-3 formulations that the FDA has classified it as
a “new chemical entity,” thus protecting it from competitors.

Is fish oil a miracle drug, how does it work, and why had previous
studies all found it to be ineffective?

Is Something Here Fishy?

Despite the market confidence, the results of this trial, called
REDUCE-IT, do not mean that everyone should go out to buy fish oil
supplements. The study did find that for those with a history of heart
disease and type II diabetes, and significantly elevated triglyceride
levels, the drug could reduce their risk of heart attacks by 25%
(when partnered with the normally-prescribed statin).

In fact, previous research seemed to demonstrate pretty conclusively that
omega-3 is not effective at preventing heart attacks (or cancer, stroke,
etc. for that matter) in the general population. The Amarin trial was so
surprisingly successful because it targeted an extremely ill and high-risk
group, and as an experimental study, it ensured that the participants took
a high dose of the purified omega-3 component daily.

Despite the caveats, for those with a history of heart disease and
diabetes, this finding could be life-saving. And considering heart disease
is still the number one killer in the developed world, and up to 80% of
those deaths are preventable, tens of millions of lives could benefit from
these results.

So how does Omega-3 actually work?

The Lesser of Two Evils

Omega-3 on its own is not a miracle drug. It is beneficial solely in
contrast to its close cousin, omega-6. Both are converted in the body into
eicosanoids, a special class of lipids (fats) which promote inflammation.
While inflammation is a normal function in response to injury, too much
can be life-threatening– inflammation is a precursor of cancer and a
catalyst for the buildup of plaques that cause heart disease.

Fortunately, omega-3 is converted into eicosanoids (the inflammatory
molecules) a lot slower than omega-6. Both compete to be converted, so
someone who eats a high ratio of omega-3 to omega-6 ends up with, in
theory, less inflammation throughout the body. In this way, omega-3 is not
actually “anti-inflammatory,” but simply the lesser of two inflammatory
evils.

A Healthy Oil

Omega-3 is a polyunsaturated fish oil, meaning that its contains multiple
double-bonds (in contrast to the unhealthy, saturated fats from meat which
do not contains these bonds). Omega-3 is one of many oils that the human
body cannot synthesize on its own and must derive from diet, thus making
it, by definition, a vitamin.

It makes perfect sense that humans would not be able to synthesize all of
the molecules we use– after all, different kinds of omega-3s are found in
plants and chicken eggs, along with marine life, meaning that anyone with
a balanced diet would consume enough of them.

Of course, nowadays, few individuals in the developed world consume a
balanced diet. Processed foods replace unsaturated fats, like Omega-3,
with saturated and trans fats, which are cheaper and less likely to spoil.

Moreover, remember that the amount of omega-3 is important as a ratio to
its “evil” twin omega-6. Some believe that as hunters and gatherers,
humans ate a diet with a roughly one-to-one ratio of the two.

Today’s agriculturalist diet has as much as thirty times more omega-6,
which exacerbates inflammation and may even lead to obesity. And it’s not
only grains and bread that pose a problem– grain-fed meat has far more
omega-6 than grass-fed. Fish and leafy vegetables, on the other hand, can
help replace omega-6 with omega-3 The richness of omega-3 and similar
nutrients in marine life may help explain why Japan, which largely
subsists on fish, has the highest life-expectancies of all major
countries. In fact, studies find that those that eat fish at least twice,
weekly, get all the benefits of Omega-3 supplements.

To Take Or Not To Take?

Ultimately, the best thing that the average person can learn from the
results of the omega-3 study is that, as a society, we must change our
approach to food. Supplements and even drug like this one cannot be
absorbed as well as nutrients found in natural products.

Those with a history of heart disease, diabetes, and high cholesterol should
talk to their heart doctor about omega-3 (along with Vitamin E to help
absorption). The rest of us would be better served eating grass-fed, leaner
meats and more fish, nuts and vegetables.

Fortunately, omega-3 is converted into eicosanoids (the inflammatory
molecules) a lot slower than omega-6. Both compete to be converted, so
someone who eats a high ratio of omega-3 to omega-6 ends up with, in
theory, less inflammation throughout the body. In this way, omega-3 is not
actually “anti-inflammatory,” but simply the lesser of two inflammatory
evils.

A Healthy Oil

Omega-3 is a polyunsaturated fish oil, meaning that its contains multiple
double-bonds (in contrast to the unhealthy, saturated fats from meat which
do not contains these bonds). Omega-3 is one of many oils that the human
body cannot synthesize on its own and must derive from diet, thus making
it, by definition, a vitamin.

It makes perfect sense that humans would not be able to synthesize all of
the molecules we use– after all, different kinds of omega-3s are found in
plants and chicken eggs, along with marine life, meaning that anyone with
a balanced diet would consume enough of them.

O f course,
nowadays, few individuals in the developed world consume a balanced diet.
Processed foods replace unsaturated fats, like Omega-3, with saturated and
trans fats, which are cheaper and less likely to spoil.

Moreover,
remember that the amount of omega-3 is important as a ratio to its “evil”
twin omega-6. Some believe that as hunters and gatherers, humans ate
a diet with a roughly one-to-one ratio of the two. Today’s agriculturalist
diet has as much as thirty times more omega-6, which exacerbates
inflammation and may even lead to obesity. And it’s not only grains and
bread that pose a problem– grain-fed meat has far more omega-6 than
grass-fed. Fish and leafy vegetables, on the other hand, can help replace
omega-6 with omega-3

The richness of omega-3 and similar nutrients in marine life may help
explain why Japan, which largely subsists on fish, has the highest
life-expectancies of all major countries. In fact, studies find that those
that eat fish at least twice, weekly, get all the benefits of Omega-3
supplements.

To Take Or
Not To Take?

Ultimately,
the best thing that the average person can learn from the results of the
omega-3 study is that, as a society, we must change our approach to food.
Supplements and even drug like this one cannot be absorbed as well as
nutrients found in natural products.

Those with
a history of heart disease, diabetes, and high cholesterol should talk to
their heart doctor about omega-3 (along with Vitamin E to help absorption).
The rest of us would be better served eating grass-fed, leaner meats and
more fish, nuts and vegetables.